services and programs

The physical medicine and rehabilitation (PM&R) department at Dayton Children's offers a wide variety of programs and services to fit each family’s needs.

spasticity management

Depending on the injury, illness or disabling condition, some physiatrists may treat patients using spasticity management. This includes prescribing medications and invasive procedures to aid in treating muscle in nerve conditions.

botulinum toxin injections (botox)

Spasticity is a muscle control disorder that is characterized by tight or stiff muscles and an inability to control those muscles. Spasticity is caused by an imbalance of signals from the central nervous system (brain and spinal cord) to the muscles. This imbalance is often found in people with cerebral palsy, traumatic brain injury, stroke, and spinal cord injury. Treatment typically includes non-invasive options such as Physical Therapy, Occupational Therapy, home stretching exercises, bracing/splinting and medications, and may also include botulinum toxin injections. Our PM&R physicians will obtain a careful history and perform a careful neuromuscular exam to determine the best method of spasticity management for your child.

what is botulinum toxin?

Botulinum toxin is a chemical that can be injected into muscles to reduce spasticity. The effects of botulinum toxin have been known since the early 1900s, but the toxin has only just been discovered to help patients with spasticity and muscle contractures. Some neurological conditions, such as cerebral palsy, can cause limbs to be tight and difficult to move. In some cases, these contracted muscles can be relaxed with botulinum toxin injections. Botulinum toxin works by blocking neural impulses to the muscles in the injected area. As a result, the muscles relax and muscle spasms are no longer able to occur.

who gets botulinum toxin injections?

Botulinum toxin therapy is used to treat patients who have spasticity that restricts function or causes pain. Usually, the spasticity affects muscles of the face, neck, arm, or leg.

Our team helps the patient and family member or caregiver identify goals before treatment begins. The treatment is done as an outpatient procedure. There is no sedation needed to inject botulinum toxin. It is very similar to receiving a standard vaccine. The skin is prepped using an alcohol swab and then sprayed with a numbing agent to numb the skin. The medicine is injected into the muscle using a small needle. The doctor may inject small amounts of botulinum toxin into several locations along the muscle group or within many muscle groups. This helps maximize the benefits of the medicine.

authorization

Prior authorization will be sent to your insurance company. Prior authorization is a check required by insurance companies or third party payers before they will agree to cover certain prescribed medications or medical procedures. Prior authorizations can take up to 14 business days to be processed. Once authorization has been obtained you will be contacted to schedule the botulinum toxin injections.

how will the injections be administered?

The amount of medicine your child receives will depend on your child’s degree of spasticity and which muscle groups are spastic or contracted. The number of injections needed depends on many factors, including the extent of the area being treated. The amount your child will be given and number of injections will be determined and discussed at your child’s initial consult visit. Botulinum toxin therapy can be repeated as early as three months after the last injection, if your child had good results and your goals were met. Dosages may need to be adjusted in order to get desired results.

Unfortunately, the effects of treatment with botulinum toxin are temporary. Periodic retreatment is necessary to maintain the therapeutic results.

after treatment

It is important to understand that botulinum toxin is an effective, ongoing treatment for the relief of symptoms — it is not a cure. Because every patient is different, the degree of relief will vary from person to person. All patients will need a daily home stretching program to help stretch the tight muscles once the botulinum toxin takes effect. Patients should resume activity slowly and carefully after botulinum toxin injection. The day of the injection it is recommended that braces not be worn and no aggressive stretching be done.

The most common side effects include discoloration, redness, pain, or discomfort at the injection site. Tylenol may given for any discomfort.

follow-up

A follow-up appointment will be made three weeks after your child’s first botulinum toxin injection to evaluate its effects and to make further treatment recommendations if needed. This appointment will be made at the same time as your child’s Botulinum toxin injection appointment.

bracing and prosthetic evaluation and prescription

PM&R physicians often prescribe braces/splints to improve arm or leg position or function, and prosthetics for limb loss. We will refer to an outside clinic for more complex bracing needs, such as the Hanger clinic.

outpatient evaluation & management of physically disabling conditions

concussion symptom management

other related programs and services

Members of the PM&R team work closely to manage each aspect of patient care. We work closely with other Dayton Children’s clinical teams to improve the patient’s functional abilities as well as provide support and education to the family. Below are the programs and services involved with PM&R.